Provider Demographics
NPI:1447301973
Name:SUNDANCE MEDICAL CENTER LLP
Entity type:Organization
Organization Name:SUNDANCE MEDICAL CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-263-4795
Mailing Address - Street 1:105 N PECOS RD
Mailing Address - Street 2:STE 113
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1995
Mailing Address - Country:US
Mailing Address - Phone:702-263-4795
Mailing Address - Fax:702-263-4804
Practice Address - Street 1:500 E WINDMILL LN STE 125
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1845
Practice Address - Country:US
Practice Address - Phone:702-263-4795
Practice Address - Fax:702-263-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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